Lipoma parosteal de arco costal: relato de caso

Os autores relatam o caso de um paciente com história de tumoração na região subaxilar esquerda, de crescimento progressivo, com início há vários anos. A radiografia e a tomografia computadorizada evidenciaram lesão expansiva com densidade menor do que partes moles adjacentes, com contornos bem definidos, contígua ao quinto arco costal esquerdo, com ossificações irregulares em seu interior. Histologicamente, foi diagnosticado lipoma parosteal, um raro tumor benigno de crescimento lento.

Bilateral giant renal angiomyolipoma associated with hepatic lipoma in a patient with tuberous sclerosis

OBJECTIVE: To report a case of bilateral giant renal angiomyolipoma associated with tuberous sclerosis, with successful treatment, and to review the literature concerning angiomyolipoma treatment. CASE REPORT: Patient with tuberous sclerosis and angiomyolipoma diagnosed by ultrasonography during her pregnancy. At that time, the angiomyolipoma on the right side was 9 cm in diameter. Conservative management was selected during her pregnancy. The patient returned 7 years later, with a 24.7 x 19.2 x 10.7 cm tumor on the right side and another of 13 x 11.5 x 6.5 cm on the left side, in addition to multiple small angiomyolipomas. A nephron-sparing surgery with tumoral enucleation was performed on the right side, and after 3 months, the tumor on the left side was removed. Renal function in the post-operative period was preserved, and contrast medium progression was uniform and adequate in both kidneys. CONCLUSION: We conclude that an angiomyolipoma larger than 4 cm should be removed surgically, since they have a greater growth rate and pose a risk of hemorrhage. Resection of smaller tumors is safe and has decreased morbidity. Tumoral enucleation is an effective treatment method that preserves kidney function.

Parosteal osteosarcoma with myocardial metastasis 13 years after follow-up

PURPOSE: To report the case of a woman with a diagnosis of grade II (low grade) parosteal osteosarcoma with the occurrence of myocardial metastasis 13 years after resection, and to present a review of the existing literature on the subject. METHODS: Description of the case and review of the literature. CONCLUSION: The review leads to the conclusion that the occurrence of metastasis from parosteal osteosarcoma can occur in up to 38% of the cases, in spite of its relatively low aggressiveness. However, myocardial metastasis of a parosteal osteosarcoma is an event that was not found in the literature.

Lipoma of the right atrium

The patient is a 54-year-old asymptomatic male with a tumor in the right atrium that was diagnosed on transesophageal echocardiography and confirmed as a lipoma of the right atrium on computerized tomography. The patient underwent surgical repair with extracorporeal circulation. The tumor was resected, and its base of implantation in the atrium was repaired with a flap of bovine pericardium. The diagnosis of lipoma was confirmed on histopathological examination. Locating of the tumor with the aid of transesophageal echocardiography was very useful in the strategy of cannulation of the venae cava for installation of the circuit of extracorporeal circulation. The patient had a good postoperative evolution.

Lipoma de ventrículo esquerdo: relato de caso

Mulher de 21 anos encaminhada com piora dos sintomas que vinha apresentando há anos: tontura ao levantar-se, sem sintomas vertiginosos, sem queixas de síncope ou alterações neurológicas, melhora em decúbito dorsal e repouso, após poucos minutos. O ecocardiograma transtorácico mostrava presença de massa hiperecogênica na região médio-apical da parede posterior do ventrículo esquerdo e pericárdio normal. A ressonância nuclear magnética cardíaca permitiu o diagnóstico de tumor de ventrículo esquerdo sugestivo de lipoma. Realizado tratamento cirúrgico e ressecado o tumor, a paciente apresentou boa recuperação e mantém-se assintomática.

Lipoma arborescens: diagnóstico e imagem

O lipoma arborescens é uma lesão intra-articular de origem desconhecida, caracterizada por proliferação vilolipomatosa crônica da membrana sinovial. Pode estar associado a doenças degenerativas, diabetes mellitus, artrite reumatóide juvenil e artrite reumatóide do adulto. O diagnóstico baseia-se em achados de ressonância magnética e de biópsia sinovial. Relatamos o caso de uma paciente do sexo feminino, de oito anos de idade, com lipoma arborescens e história de artrite em joelhos e cotovelos há dois anos, tendo sido observada melhora parcial da artrite após o início do tratamento medicamentoso convencional.

Osteossarcoma parosteal: aspectos na radiologia convencional

OBJETIVO: Avaliar os achados clínicos mais importantes do osteossarcoma parosteal e descrever os seus aspectos mais comuns na radiologia convencional. MATERIAIS E MÉTODOS: Estudo retrospectivo com 26 pacientes com osteossarcoma parosteal, provenientes do arquivo do Clube do Osso, Rio de Janeiro, RJ, e análise dos principais achados clínicos e aspectos radiológicos. RESULTADOS: A doença predominou em pacientes do sexo feminino e teve idade média de acometimento na terceira década de vida. Os achados clínicos mais freqüentes foram o aumento do volume no local do tumor (77% dos casos) e a dor local (68% dos casos). O local mais comum de tumor foi o oco poplíteo, com 40% dos casos, e houve envolvimento metafisário em 92% dos tumores. O aspecto radiológico mais comumente encontrado foi de lesão bem mineralizada e intimamente justaposta à superfície óssea, com o córtex adjacente irregularmente espessado (92,3% dos casos), observando-se área de adesão a este (88,5% dos casos), além de margens tumorais lobuladas (50% dos casos) ou irregulares (38,5% dos casos). Evidenciaram-se, também, linha radiolucente entre o tumor e o osso adjacente (48% dos casos), padrão de mineralização mais denso na base do que na periferia (42,3% dos casos) e pequena ocorrência de reação periosteal (15,4% dos casos). CONCLUSÃO: Apesar de a tomografia computadorizada e a ressonância magnética serem importantes na identificação de alguns aspectos do osteossarcoma parosteal, a radiologia convencional é altamente sugestiva deste tumor e permite, na maior parte dos casos, o diagnóstico diferencial com outras lesões da superfície óssea.

Intraosseous lipoma: radiological findings

OBJECTIVE: Intraosseous lipomas may be less rare lesions than previously suggested in the literature. They have frequently been misdiagnosed as other benign bone lesions. A combination of computed tomography, magnetic resonance imaging and radiography is essential for decreasing misdiagnosis rates. MATERIALS AND METHODS: This retrospective study presents ten cases of intraosseous lipoma. The patients' ages ranged from 25 to 80 years, and six of them were female. Six patients presented with bone pain, whereas four patients were asymptomatic with incidentally discovered lesions. The involved bones were: femur (four patients), tibia (two patients), calcaneus (one patient), sacrum (one patient), iliac bone (one patient), navicular bone (one patient). All of the patients were assessed by means of conventional radiography, computed tomography and magnetic resonance imaging of the affected region. RESULTS: In all of the cases, plain films revealed well-defined lytic lesions. Both computed tomography and magnetic resonance imaging were quite useful in demonstrating fat within the femur. The histologic pattern of all tumors was that of mature adipose tissue. CONCLUSION: Intraosseous lipoma is a well-defined entity that may develop with varying presentations. Plain radiographs alone cannot establish the diagnosis of this lesion. However, both computed tomography and magnetic resonance imaging are quite useful methods in these cases.

Lipoma espinhal associado a seio dérmico congênito: relato de caso

Os lipomas espinhais são raros, respondendo por 1% de todos os tumores espinhais, estando associados ao disrafismo espinhal oculto em mais de 99% dos casos. Estão divididos em três tipos principais: lipomielomeningocele, lipoma intradural e fibrolipoma do filo terminal. Este relato descreve um caso de lipoma lombossacral congênito associado a estigma cutâneo do tipo seio dérmico lombar congênito.

Lipoma da cabeça do pâncreas

Intrapancreatic lipoma is an extremely rare neoplasm. The authors present a case of pancreatic lipoma in a 51-years-old white female, with a history of abdominal pain for a twelve-month period, without other findings. Computed tomography scanning showed a 5cm tumor located at the head of the pancreas. After surgical excision of a solid mass, histological study reveled a benign neoplasm of fat-cells, surrounded for normal pancreatic tissue. The authors comment on the more important aspects of this pathology.

Hérnia de Morgagni simulando lipoma torácico

The Morgagni hernia is the rarest kind of diaphragmatic hernia , occurring in 3% of all cases. It consists of the protrusion of the abdominal content into the thoracic cavity including omentum and transverse colon, among others. It is more common in the right side and appears more frequently after 40 years of age or after a raise in the intra-abdominal pressure. Patients with Morgagni hernia are usually asymptomatic. In the X-ray it appears like an opaque image in the cardiophrenic angle.Surgical correction is the treatment of choice for this conditions. We present one case of Morgagni hernia successfully treated.

Lipoma gástrico: relato de caso

We report a case of gastric lipoma, a rare benign stomach tumor. There are approximately 200 cases previously described in literature. A male, 62-year-old patient with no clinical complaint presented a tumor lesion in the stomach antrum found in a routine upper endoscopy. A surgical resection (subtotal gastrectomy) was done and the histological examination showed submucosal lipoma without signs of malignancy. This report points to the growth of routine examination in the current clinical practice and the dilemma brought by overdiagnosis.

Dirofilariasis involving the oral cavity: report of the first case from South America

Oral dirofilariasis is very rare with non-specific clinical manifestations. Here, we report the case of a 65-year-old South American woman with a submucosal nodule on her right buccal mucosa. The nodule was slightly tender and painful. Differential diagnoses included mesenchymal (lipoma or fibrolipoma, solitary fibrous tumor, and neurofibroma) or glandular benign tumors (pleomorphic adenoma) with secondary infections. We performed excisional biopsy. A histopathological examination revealed a dense fibrous capsule and a single female filarial worm showing double uterus appearance, neural plaque, well-developed musculature and intestinal apparatus. Dirofilariasis was diagnosed, and the patient was followed-up for 12 months without recurrence.

Primary neoplasms of the heart. Clinical and histological presentation of 50 cases

OBJECTIVE: To analyze clinical and histologic findings of 50 patients with primary neoplams of the heart in a tertiary referral center. METHODS: From 1980 to 1998, we retrospectively analyzed 50 patients, 32 of whom were females, whose ages ranged from 9 to 73 years (mean age = 44.16±18 years). RESULTS: Most tumors were located in the left side of the heart (72%), myxoma being the most common (84%) histologic type. The other histologic types found were as follows: fibroma (4%), lipoma (2%), rhabdomyosarcoma (2%), hemangioma (2%), sarcoma (2%), angiosarcoma (2%), and lymphoma (2%). Diagnosis was established by echocardiography in 94% of the cases. Clinical findings were as follows: dyspnea (36%), weight loss (20%), palpitations (18%), chest pain (16%), fever (8%), and arthralgia (6%). All patients with thromboembolic phenomena (10%) had left atrial myxoma. Approximately 20% of the patients were asymptomatic at the initial clinical assessment. CONCLUSION: Primary cardiac tumors are a rare entity with diverse clinical and histologic findings, requiring, therefore, a high level of clinical suspicion.